A.C.M. is supported by K23DK08433 and the Dept. of Medicine, Beth Israel Deaconess Medical Center (BIDMC); R.A.M. is supported by 5K23CA139005 and the Dept. of Medicine, BIDMC, and the Clinical Investigator Training Program: BIDMC, Harvard/MIT Health Sciences and Technology, in collaboration with Pfizer Inc. and Merck & Co. Funding sources had no role in study design, data collection, data analysis, data interpretation, writing of the article, or the decision to submit for publication. Conflict of Interest Disclosure: G.D. and R.M. have no competing interests to declare. A.C.M.: research funding (Proctor & Gamble, Shire and Salix), advisory board (UCB, Abbott), speaker's honorarium (Abbott, Schering-Plough). A.S.C.: speaker's honoraria (Proctor & Gamble, Centocor), advisory board (Abbott, UCB).
Comparative cost-effectiveness of strategies to prevent postoperative clinical recurrence of Crohn's disease†
Article first published online: 8 SEP 2011
Copyright © 2012 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 18, Issue 9, pages 1608–1616, September 2012
How to Cite
Doherty, G. A., Miksad, R. A., Cheifetz, A. S. and Moss, A. C. (2012), Comparative cost-effectiveness of strategies to prevent postoperative clinical recurrence of Crohn's disease. Inflamm Bowel Dis, 18: 1608–1616. doi: 10.1002/ibd.21904
- Issue published online: 9 AUG 2012
- Article first published online: 8 SEP 2011
- Manuscript Accepted: 25 AUG 2011
- Manuscript Received: 29 JUL 2011
- Crohn's disease;
- decision analysis;
A number of treatments have been shown to reduce the risk of postoperative recurrence of Crohn's disease (CD). The optimal strategy is unknown. The aim was to evaluate the comparative cost-effectiveness of postoperative strategies to prevent clinical recurrence of CD.
Three prophylactic strategies were compared to “no prophylaxis”; mesalamine, azathioprine (AZA) / 6-mercaptopurine (6-MP), and infliximab. The probability of clinical recurrence, endoscopic recurrence, and therapy discontinuation due to adverse drug reactions (ADRs) were extracted from randomized controlled trials (RCTs). Quality-of-life scores and treatment costs were derived from published data. The primary model evaluated quality-adjusted life years (QALYs) and cost-effectiveness at 1 year after surgery. Sensitivity analysis assessed the impact of a range of recurrence rates on cost-effectiveness. An exploratory analysis evaluated cost-effectiveness outcomes 5 years after surgery.
A strategy of “no prophylaxis” was the least expensive one at 1 and 5 years after surgery. Compared to this approach, AZA/6-MP had the most favorable incremental cost-effectiveness ratio (ICER) ($299,188/QALY gained), and yielded the highest net health benefits of the medication strategies at 1 year. Sensitivity analysis determined that the ICER of AZA/6-MP was preferable to mesalamine up to a recurrence rate of 52%, but mesalamine dominated at higher rates. In the 5-year exploratory analysis, mesalamine had the most favorable ICER over 5 years ($244,177/QALY gained).
Compared to no prophylactic treatment, AZA/6-MP has the most favorable ICER in the prevention of clinical recurrence of postoperative CD up to 1 year. At 5 years, mesalamine had the most favorable ICER in this model. (Inflamm Bowel Dis 2012;)